Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Centre Jean Perrin, Clermont-Ferrand, France.
Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
Brachytherapy. 2024 Nov-Dec;23(6):719-726. doi: 10.1016/j.brachy.2024.07.003. Epub 2024 Oct 2.
Brachytherapy as monotherapy is a recommended treatment option for men with low to intermediate risk prostate cancer. Local recurrence is difficult to identify. This study investigated PSMA PET/CT for recurrence after brachytherapy, as well as their subsequent management when recurrence occurred only within the prostate.
We performed a retrospective single-center analysis for patients who were treated with brachytherapy as monotherapy for prostate cancer from May 2002 to May 2021 and who underwent a PSMA PET/CT for BCR. We report the findings on PSMA PET/CT, quantitative parameters, as well as the later management of the patients.
Forty patients were identified, who underwent PSMA PET/CT to investigate a rising PSA at a median (IQR) of 7 years (3.0-10.8) after initial therapy. Median (IQR) PSA at time of PSMA PET/CT was 6.54 ng/mL (3.9-15.5). On PSMA PET/CT, 20/40 (50%) men had prostate-only recurrence. Of the 20 patients with prostate-only recurrence, 8/20 (40%) had recurrence in a high-dose radiation zone, versus 7/20 (35%) in an under-covered zone. On PSMA PET/CT, recurrence within the prostate had median (IQR) SUVmax 10.4 (5.1-15.7) and volume 2.9 mL (2.0-11.2). Subsequent management of these patients with local recurrence included surveillance followed by ADT (9/20, 45%). For those with surveillance followed by ADT, the mean time before introduction of ADT was 4.1 years (range 1-8 years).
单纯近距离放疗是低危到中危前列腺癌患者的一种推荐治疗选择。局部复发难以识别。本研究调查了 PSMA PET/CT 在近距离放疗后复发的情况，以及当复发仅发生在前列腺内时的后续管理。
我们对 2002 年 5 月至 2021 年 5 月期间接受单纯近距离放疗治疗前列腺癌且行 PSMA PET/CT 检查以监测生化复发（BCR）的患者进行了回顾性单中心分析。我们报告了 PSMA PET/CT 的结果、定量参数以及患者的后续管理。
共确定了 40 名患者，他们在初始治疗后中位（IQR）7 年（3.0-10.8）时因 PSA 升高而行 PSMA PET/CT 检查。PSMA PET/CT 时的中位（IQR）PSA 为 6.54ng/mL（3.9-15.5）。在 PSMA PET/CT 上，20/40（50%）名男性出现单纯前列腺复发。在 20 名单纯前列腺复发的患者中，8/20（40%）患者在高剂量放疗区复发，而 7/20（35%）患者在未覆盖区复发。在 PSMA PET/CT 上，前列腺内复发的 SUVmax 中位数（IQR）为 10.4（5.1-15.7），体积为 2.9mL（2.0-11.2）。这些局部复发患者的后续管理包括监测随访和 ADT（9/20，45%）。对于接受监测随访和 ADT 的患者，引入 ADT 的平均时间为 4.1 年（范围 1-8 年）。
